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← SALEM PHYSICIAN PRACTICES PC

Form 990 for tax year 2023

Filed by SALEM PHYSICIAN PRACTICES PC.

Totals

Total revenue
$823,661
Total expenses
$4,604,806
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$823,661
Investment income
$0
Other revenue
$0
Total assets, end of year
$156,269
Total liabilities, end of year
$4,016,955
Net assets or fund balances, end of year
-$3,860,686
Program services expenses (Part IX)
$4,144,326
Management and general expenses
$460,480
Fundraising expenses
$0
Program service expenses (Part III)
$4,144,326

Program services were 90.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: NET PATIENT SERVICE REVENUE

    total $823,661 · related or exempt $823,661

  • 3 · Investment income

    total $0

  • 4 · Income from investment of tax-exempt bond proceeds

    total $0

  • 5 · Royalties

    total $0

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 6d · Net rental income or loss

    total $0

  • 7d · Net gain or loss

    total $0

  • 8a · Fundraising events: gross income

    $0

  • 8b · Fundraising events: direct expenses

    $0

  • 8c · Net income from fundraising events

    total $0

  • 9a · Gaming: gross income

    $0

  • 9b · Gaming: direct expenses

    $0

  • 9c · Net income from gaming

    total $0

  • 10a · Gross sales of inventory

    $0

  • 10b · Cost of goods sold

    $0

  • 10c · Net income from sales of inventory

    total $0

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $0

  • 2 · Grants to domestic individuals

    total $0

  • 3 · Grants to foreign organizations and individuals

    total $0

  • 4 · Benefits paid to or for members

    total $0

  • 5 · Compensation of officers, directors and key employees

    total $0

  • 6 · Compensation of disqualified persons

    total $0

  • 7 · Other salaries and wages

    total $1,619,689 · program services $1,457,720 · management and general $161,969

  • 8 · Pension plan contributions

    total $0

  • 9 · Other employee benefits

    total $259,172 · program services $233,255 · management and general $25,917

  • 10 · Payroll taxes

    total $109,517 · program services $98,565 · management and general $10,952

  • 11a · Fees: management

    total $213,836 · program services $192,452 · management and general $21,384

  • 11b · Fees: legal

    total $1,179 · program services $1,061 · management and general $118

  • 11c · Fees: accounting

    total $0

  • 11d · Fees: lobbying

    total $0

  • 11e · Fees: professional fundraising services

    total $0

  • 11f · Fees: investment management

    total $0

  • 11g · Fees: other

    total $255,413 · program services $229,872 · management and general $25,541 · fundraising $0

  • 12 · Advertising and promotion

    total $0

  • 13 · Office expenses

    total $111,620 · program services $100,458 · management and general $11,162

  • 14 · Information technology

    total $245,256 · program services $220,730 · management and general $24,526

  • 15 · Royalties

    total $0

  • 16 · Occupancy

    total $37,614 · program services $33,853 · management and general $3,761

  • 17 · Travel

    total $0

  • 18 · Travel or entertainment for public officials

    total $9,240 · program services $8,316 · management and general $924

  • 19 · Conferences, conventions and meetings

    total $0

  • 20 · Interest

    total $2,413 · program services $2,172 · management and general $241

  • 21 · Payments to affiliates

    total $0

  • 22 · Depreciation, depletion and amortization

    total $1,557,996 · program services $1,402,196 · management and general $155,800

  • 23 · Insurance

    total $65,185 · program services $58,667 · management and general $6,518

  • 24a · Other expenses: MEDICAL SUPPLIES

    total $99,534 · program services $89,581 · management and general $9,953

  • 24b · Other expenses: DUES & SUBSCRIPTIONS

    total $17,142 · program services $15,428 · management and general $1,714

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $18,504 · end of year $12,516

  • 2 · Savings and temporary cash investments

    beginning of year $0 · end of year $0

  • 3 · Pledges and grants receivable

    beginning of year $0 · end of year $0

  • 4 · Accounts receivable

    beginning of year $566,518 · end of year $3,769

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 7 · Other notes and loans receivable

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $98,183 · end of year $98,183

  • 9 · Prepaid expenses and deferred charges

    beginning of year $36,177 · end of year $9,762

  • 10a · Land, buildings and equipment: cost or other basis

    $28,678

  • 10b · Land, buildings and equipment: accumulated depreciation

    $10,825

  • 10c · Land, buildings and equipment, net

    beginning of year $19,886 · end of year $17,853

  • 11 · Investments: publicly traded securities

    beginning of year $0 · end of year $0

  • 12 · Investments: other securities

    beginning of year $0 · end of year $0

  • 13 · Investments: program-related

    beginning of year $0 · end of year $0

  • 14 · Intangible assets

    beginning of year $19,620,001 · end of year $0

  • 15 · Other assets

    beginning of year $63,399 · end of year $14,186

  • 17 · Accounts payable and accrued expenses

    beginning of year $1,606,780 · end of year $1,491,584

  • 18 · Grants payable

    beginning of year $0 · end of year $0

  • 19 · Deferred revenue

    beginning of year $0 · end of year $0

  • 20 · Tax-exempt bond liabilities

    beginning of year $0 · end of year $0

  • 21 · Escrow or custodial account liability

    beginning of year $0 · end of year $0

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $0 · end of year $0

  • 24 · Unsecured notes and loans payable

    beginning of year $0 · end of year $0

  • 25 · Other liabilities

    beginning of year $18,895,429 · end of year $2,525,371

  • 27 · Net assets without donor restrictions

    beginning of year -$79,541 · end of year -$3,860,686

  • 28 · Net assets with donor restrictions

    beginning of year $0 · end of year $0

Mission and programs · 2023

Mission

TO PROVIDE PRIMARY CARE AND SPECIALTY MEDICAL SERVICES IN FURTHERANCE OF THE CHARITABLE TAX-EXEMPT PURPOSES OF INSPIRA MEDICAL CENTERS, INC.; AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION.

Activities or mission (Part I)

TO PROVIDE PRIMARY CARE AND SPECIALTY MEDICAL SERVICES IN FURTHERANCE OF THE CHARITABLE TAX-EXEMPT PURPOSES OF INSPIRA MEDICAL CENTERS, INC.; AN IRC 501(C)(3) TAX-EXEMPT ORG.

  • EXPENSES INCURRED TO PROVIDE PRIMARY CARE AND SPECIALTY MEDICAL SERVICES IN FURTHERANCE OF THE CHARITABLE TAX-EXEMPT PURPOSES OF INSPIRA MEDICAL CENTERS, INC.; AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT HOSPITAL ORGANIZATION.

    Expenses $4,144,326 · Revenue $823,661

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Scott E Wagner MD MBA

    PresIDENT - Trustee

    Total calculated
    $673,124
    From this org
    $0
    From related orgs
    $566,936
    Other
    $106,188
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $0 + $452,404 related
    Bonus
    $0 + $75,888 related
    Other
    $0 + $38,644 related
    Deferred
    $0 + $75,898 related
    Nontaxable benefits
    $0 + $30,290 related
    Filer's total
    $0 + $673,124 related

  • Daniel S Timmerman Domph

    general surgeon

    Total calculated
    $631,463
    From this org
    $174,031
    From related orgs
    $431,124
    Other
    $26,308
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $173,681 + $431,124 related
    Bonus
    $0
    Other
    $350
    Deferred
    $0
    Nontaxable benefits
    $7,575 + $18,733 related
    Filer's total
    $181,606 + $449,857 related

  • Michael Levy MD

    Orthopedic Surgeon

    Total calculated
    $545,678
    From this org
    $140,415
    From related orgs
    $363,662
    Other
    $41,601
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $139,075 + $358,743 related
    Bonus
    $0
    Other
    $1,340 + $4,919 related
    Deferred
    $0
    Nontaxable benefits
    $16,529 + $25,072 related
    Filer's total
    $156,944 + $388,734 related

  • Harish Kakkilaya MD

    Bariatric Surgeon

    Total calculated
    $514,871
    From this org
    $257,012
    From related orgs
    $232,733
    Other
    $25,126
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $256,253 + $231,476 related
    Bonus
    $0
    Other
    $759 + $1,257 related
    Deferred
    $0
    Nontaxable benefits
    $7,794 + $17,332 related
    Filer's total
    $264,806 + $250,065 related

  • Paul R Kouyoumdji MD

    PEDIATRICIAN

    Total calculated
    $267,483
    From this org
    $108,487
    From related orgs
    $125,960
    Other
    $33,036
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $107,594 + $124,748 related
    Bonus
    $0
    Other
    $893 + $1,212 related
    Deferred
    $0
    Nontaxable benefits
    $25,106 + $7,930 related
    Filer's total
    $133,593 + $133,890 related

  • Henry C Ho MD

    Gastroenterologist

    Total calculated
    $195,135
    From this org
    $195,135
    From related orgs
    $0
    Other
    $0
    Hours/week
    55

    Schedule J breakdown matched by us

    Base
    $194,805
    Bonus
    $0
    Other
    $330
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $195,135

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Form 990 of other organizations
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

SCHEDULE J, PART I; QUESTION 4B
THE AMOUNT REFLECTED IN SCHEDULE J, PART II, COLUMN B(III) FOR THE FOLLOWING INDIVIDUAL INCLUDES CURRENT YEAR VESTING IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) AS THE AMOUNT Was NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THE AMOUNT OUTLINED HEREIN WAS INCLUDED IN hiS 2023 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: SCOTT E. WAGNER, M.D., MBA, $9,778. THE DEFERRED COMPENSATION AMOUNT REFLECTED IN SCHEDULE J, PART II, COLUMN C FOR THE FOLLOWING INDIVIDUAL INCLUDES UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THIS INDIVIDUAL MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNT OUTLINED HEREIN WAS NOT INCLUDED IN HIS 2023 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: SCOTT WAGNER, M.D., MBA, $56,386.
SCHEDULE J, PART I; QUESTION 7
CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2023 WHICH WAS INCLUDED IN SCHEDULE J, PART II, COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2023 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.
SCHEDULE J, PART II; COLUMN B(III)
CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J OF THIS FEDERAL FORM 990 RECEIVED COMPENSATION WITH RESPECT TO PAID TIME OFF, WHICH WAS INCLUDED IN SCHEDULE J, PART II, COLUMN B(III) HEREIN AND IN EACH INDIVIDUAL'S 2023 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES.
SCHEDULE J, PART II; COLUMN F
THE AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN (F) INCLUDE VESTED BENEFITS IN A DEFERRED COMPENSATION PLAN AS THESE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THESE AMOUNTS WERE REPORTED AS DEFERRED COMPENSATION ON PRIOR YEARS' FORMS 990 AND ARE NOW BEING REPORTED AGAIN ON THIS YEAR'S FORM 990. THESE AMOUNTS HAVE BEEN TREATED AS TAXABLE INCOME AND WERE REPORTED ON EACH INDIVIDUAL'S FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • BPOC LP

    REAL ESTATE · NJ

    Directly controlled by NA

  • INSPIRA HLTH PTRS

    HEALTHCARE ACO · NJ

    Directly controlled by NA

  • INSPIRA SJ UC MGT

    URGENT CARE MGT · NJ

    Directly controlled by NA

  • WMCA LLP

    HEALTHCARE SVCS. · NJ

    Directly controlled by NA

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • INSPIRA HEALTH MANAGEMENT CORPORATION

    C CORP. · HEALTHCARE SVCS. · NJ

    Directly controlled by NA

  • JUNO ASSURANCE LTD

    FOREIGN CORP. · FINANCIAL VEHICLE · BD

    Directly controlled by NA

  • INSPIRA HEALTH NETWORK URGENT CARE PC

    C CORP. · HEALTHCARE SVCS. · NJ

    Directly controlled by NA

  • RED BANK DEVELOPMENT CORPORATION

    C CORP. · HEALTHCARE SVCS. · NJ

    Directly controlled by NA

  • INSPIRA SJ URGENT CARE PC

    C CORP. · HEALTHCARE SVCS. · NJ

    Directly controlled by NA

Provenance

Return type
form_990
Tax year
2023
Filed
15 May 2024
IRS schema version
2023v5.1
Source object
202413199349315566

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